Are vaccines really necessary? Yes. Last year alone vaccines pre-

vented 14 million infections and33,000 deaths in the United States.

So why are parents deciding todelay, or not vaccinate their chil-dren? Celebrity hype in the mediareporting inaccurate autism informa-tion is attributed to many parentshaving concerns about vaccinatingtheir children.

New materials created by health-care professionals to use to addressparental refusal of vacciness will berolled out at the 2010 Ohio AAPAnnual Meeting, Nov. 5 and 6. TheHealthy People 2010 Advisory Com-mittee is hoping these materials will

assist pediatricians in answeringsome of the most commonly-askedquestions posed by parents regardingvaccine safety.

Ari Brown, MD, official spokes-person for the American Academy ofPediatrics and guest speaker at theAnnual Meeting, says, “I havewatched a child die from a vaccine-preventable disease while I helpless-ly stood by. Delaying your child’sshots is playing Russian Roulette.”

“And no, you can’t just let every-one else vaccinate their kids – andlet them protect your un-vaccinatedchild,” she says. Since vaccination,serious infections have been reduced

See Annual Meeting...on page 6

Newsmagazine of the Ohio Chapter, American Academy of Pediatrics Fall 2010

In this issue:• Case Study: The Female

Athlete Triad

• Sports Shorts

• 2010 Foundation Golf Outing recap

• Teen breastfeeding study

Wine Raffle tobenefit Foundation

A bottle of white, a bottle of red,

perhaps a bottle of rose instead...

The Ohio AAP Foundation will

host a wine raffle at the Opening

Reception of the Annual Meeting

Friday, Nov. 5 from 6:30-8 p.m.

If your ticket is drawn, you may

choose a bottle of wine. However,

you will not know what wine it is,

because bottles are covered in

brown bags and are only identified

by the red or white ribbon on the

bag!

Tickets for the wine raffle are $10

each or 3 for $20. You can pre-order

your Wine Raffle tickets online at

www.ohioaap.org, or by mailing

your information and payment to:

Ohio AAP Foundation, 450 W.

Wilson Bridge Rd., Suite 215,

Worthington, OH 43085.

If you are attending the Opening

Reception, you can also purchase a

“special” drink in support of the

Ohio AAP Foundation.

Healthy People 2010 materialsrolled out at Annual Meeting

Clark Kellogg, CBS Sports College Basketball Analyst, was the guest reader at

Breakfast for Books, the annual fundraiser for Reach Out and Read Ohio.

Reading Goodnight Moon to the attendees with Kellogg are Ali and Emily

Matta, daughters of OSU Men’s Head Basketball Coach Thad Matta. For more

photos see page 13.

See Legislation...on page 14

Ohio Pediatrics • Fall 20102

Ohio Pediatrics

A Publication of the Ohio Chapter,

American Academy of Pediatrics

Officers

President....Gerald Tiberio, MD, FAAP

President-Elect.....Judith Romano, MD, FAAP

Treasurer....Andrew Garner, MD, PhD, FAAP

Delegates-at-large:

Jill Fitch, MD, FAAP

Allison Brindle, MD, FAAP

Robert Murray, MD, FAAP

Executive Director:Melissa Wervey Arnold450 W. Wilson Bridge Road, Suite 215

Worthington, OH 43085

(614) 846-6258, (614) 846-4025 (fax)

Lobbyist:Dan Jones Capitol Consulting Group

37 West Broad Street, Suite 820

Columbus, OH 43215

(614) 224-3855, (614) 224-3872 (fax)

Editor:Karen Kirk(614) 846-6258 or (614) 486-3750

www.ohioaap.org

All eyes are on battle for governor seatLooking at Ohio’s political land-

scape, all eyes are on the contentiousbattle for the Governor’s office asformer Congressman John Kasich(Republican) challenges incumbentGov. Ted Strickland (Democrat).

Both political parties will also befocused on victories in the Auditor’soffice and Secretary of State’s of-fice, two critical positions that playroles in redrawing the lines that de-termine legislative districts for thenext 10 years. Additionally, a num-ber of races for seats in the OhioHouse will also be closely watchedas Republicans look to shift the 53-46 Democrat majority makeup ofthis important chamber.

A review of the key races of inter-est in Ohio follows.

Federal Offices

U.S. Senate

The open seat in the U.S. Senatewith the retirement of RepublicanSen. George Voinovich gets top bill-ing in federal races in Ohio. Demo-cratic Lt. Governor Lee Fisher willface former Republican Congress-man Rob Portman in the generalelection in November.

The Senate is composed of 57Democrats, 41 Republicans, and twoindependents who caucus with theDemocrats. If Democrats lose a netof 10 or more seats or caucus mem-bers in 2010, they'll lose U.S. Senatecontrol. Senate seats in Arkansas,Indiana and North Dakota are ex-pected to change from Democraticto Republican. Seven Senate seatsnow held by Democrats are in closeraces and could be lost to Republi-cans: California, Colorado, Illinois,

Nevada, Pennsylvania, Washingtonand Wisconsin. Previously, Senateseats in Missouri, Kentucky, andOhio could have changed from Re-publican to Democratic. As of Sep-tember, though, Republicans aresolidly leading all three races.

U.S. House of Representatives

Ohio’s 18 members of the U.S.House will be running for re-elec-tion this November. Republicans inOhio and across the country will beworking to win key swing districtslost in the previous two elections in-cluding the following: District 1held by Democrat Steve Driehaus,District 15 held by Democrat Con-gresswoman Mary Jo Kilroy, District17 held by Democrat John Boccieriand District 18 held by DemocratZack Space. The U.S. House cur-rently has 256 Democrat membersand 178 Republican members. Achange in control from Democrat toRepublican would be a tough, butnot impossible, challenge. In aSeptember 10 column, University ofVirginia’s Larry Sabato wrote:"Given what we can see at thismoment, Republicans have a goodchance to win the House by pickingup as many as 47 seats, net."

Ohio’s Statewide Offices

Ohio Governor

The gloves came off early in therace to serve as Ohio’s governor.Negative messaging in commercialsand web videos have come fromboth Kasich and Strickland cam-paigns since April. Early polls –Quinnipiac, Rasmussen Reports,University of Cincinnati and Public

Policy Polling – have bounced thelead between the two candidates inrecent months. However in recentweeks, the polls have shown Kasichwinning by as much as 17 percentagepoints. Gov. Strickland bears theweight of Ohio’s failing economy,while Kasich’s Achilles Heel is histime working for Lehman Brothers,the investment firm tied to the 2008collapse of the financial market.However, as those who have watchedpolitics over the years know, muchcan happen in the last few weeks anddays leading up to the election.

2010 Election Preview

At the beginning

of the summer,

one of the first

tasks undertaken

in Dr. Tiberio’s

term as president

was to survey the

membership and

begin to reach out

to our members to

determine the best

way to meet their

needs.

We tried to de-

termine not only

what type of edu-

cational offerings

were needed, but

in addition, we

wanted to know

the challenges that

our members face on a daily basis

so as to strategically plan for the

future.

We want to thank all of our mem-

bers who took time out of their busy

schedules to fill out the membership

survey. In this article, we will high-

light a few of the results and give

you feedback on what the Chapter is

doing to address some of these is-

sues.

The first part of the survey fo-

cused on educational opportunities,

and not surprisingly, obesity, nutri-

tion, and physical fitness led as the

Chapter focus recommendation.

This was reassuring news to the

Chapter leadership, because the

Chapter has spent the last year fo-

cusing our efforts in these areas.

Under the leadership of Dr. Amy

Sternstein and Dr. Robert Murray,

we have secured a grant from the

Ohio Department of Health (ODH)

to train pediatricians and other

health-care professionals on The

Ounce of Prevention – an anticipa-

tory guidance program developed in

partnership with other like-minded

organizations. The grant has allowed

us to develop a four-part free train-

ing program, which includes: re-

gional CME trainings, webinars, a

learning collaborative that will satis-

fy your MOC part IV requirement,

and a website aimed not only at

pediatricians, but also at parents and

adolescents. For more information

on the program, you can go to www.

theounceofprevention.org,

In terms of challenges, the num-

ber one challenge was MOC part IV.

This again is something the Chapter

leadership had anticipated. We have

spent a great deal of time and ener-

gy working with our partners at Cin-

cinnati Children’s Center for Health-

care Quality and National AAP to

develop free programs that met

these requirements for our members.

Currently we offer three pro-

grams that satisfy the MOC part IV

requirement – Ounce of Prevention

focusing on addressing the issue of

childhood obesity; Concerned

About Development Learning

Collaborative focusing on develop-

mental screening; and the Pedia-

tric Asthma Care program focusing

on asthma. Right now, the Ohio

Chapter leads EVERY other AAP

chapter with the most programs

available to their members. We hope

to continue to offer additional op-

portunities to assist members in this

process.

Another challenge was the issue

of vaccine misinformation and pa-

rental refusal of vaccines. This has

been a concern for the last decade,

and the Chapter has explored nu-

merous ways to try to assist mem-

bers in this area.

For example, with the Maximi-

zing Office Based Immunization

program that the Chapter adminis-

ters through a grant from ODH, we

have recently updated the program

to include some resources in this

area.

In addition, last year we obtained

a grant from AAP to develop mate-

rials aimed at families that pediatri-

cians can use in their practices to

save time addressing these concerns

during a patient visit. These materi-

als have gone through several

rounds of focus group testing and

will be rolled out at the Chapter’s

Annual Meeting in November.

And finally, this year’s Annual

Meeting will solely focus on vac-

cines and parental refusal. We are

bringing in national experts to ad-

dress these concerns, Ari Brown,

MD, and Meg Fisher, MD, as well

as offering programming around the

new materials we have developed,

some common infectious disease

case studies, and coding reimburse-

ment focused on vaccines.

Another major concern is health-

care reform and Medicaid reim-

bursement, especially with the in-

creased population of children who

will soon be eligible for Medicaid.

Over the past two years, the Chapter

has worked hard to not only protect

Medicaid rates from further cuts,

but in addition, we were also able to

See Survey...on page 12

Ohio Pediatrics • Fall 2010 3

Ohio Pediatrics

www.ohioaap.org

Message from the President and Executive Director

Gerald Tiberio, MD

Melissa Wervey Arnold

Chapter to address issues raised in survey

Ohio Pediatrics • Fall 20104

Advertisement

www.ohioaap.org

Learn more–

© 2009 National Dairy Council®. Fuel Up is a service mark of National Dairy Council. Fuel Up To Play 60 and the Fuel Up To Play 60 logo are trademarks and service marks of the National Football League. © 2009 NFL Properties LLC. All NFL-related trademarks are trademarks of the National Football League.

These health and nutrition organizations support

Fuel Up to Play 60, a partnership between

the NFL and National Dairy Council impacting an

expected 60,000 schools and 36.6 million students.

This program empowers

youth to make changes at

school that will help them

“fuel up” with nutrient-rich

foods missing from

their diets, such as

low-fat and fat-

free milk and milk

products, fruits,

vegetables and

whole grains and to

“get active and play”

for 60 minutes daily.

www.FuelUpToPlay60.com

www.NationalDairyCouncil.org

ww

oPlay.FuelUpTww

ww

y60.com

NationalDairyww

gCouncil.or

ww

.NationalDairyww

g

© 2 0 0 9 N a at i U p is a service mark o i s a service mark o a service mark o s e r rvice mark o i c Council. FuelF Fu e l U p o P TTTo Play 60 logo arT a n d service mark s e r rv i ce mark e mFo o ot b a l l Leeag L© 2 0 0 9 N F L Prrelate ed tr t radet h e National F N a at i o n a l

Co

o na a l Dairy Council®. Fuel Dairy Council®. Fuel a i ry Council®. Fuel y Council®. Fuel C Co u n c il®. Fuel l® ® . Fuel u e l c e mark o m a r k of N a t i o n a l Dairy a i r ry

Up To Play 60 and the TTo l ay 60 logo ar ay 60 logo ar 6 0 logo ar logo ar o g o are e t radeemarksk r

m a r s s of t h e National a ational i o n a l k kguue..

L Pr Pr ro perties LLe r rties LLi e es LL L C C . A Al l NFL N F FL- L LLemarks ar a e e t rademar s os o of okk rk

o ot ot b a l l Leaguue.. F

Ohio Pediatrics • Fall 2010 5

Ohio Pediatrics

www.ohioaap.org

Case Study: The female athlete triad

Editor’s note: The author of thiscase study, Anastasia Fischer, MD,is a pediatrician in the Departmentof Sports Medicine at NationwideChildren’s Hospital in Columbus.

Case presentation:

A 15-year-old female cross-coun-try runner presents to your officewith right shin pain. Pain startedabout two weeks into the season(four weeks ago), and although it isworse with running, it has now be-gun to hurt with even walking. Nohistory of injury. No history of pre-vious similar pain. No radiation ofpain. No numbness, tingling, heavyfeeling, or tightness noted. Shebought new running shoes this sea-son, that are particular to her foottype (assessed at a local runningstore). She is now running crosscountry on the high school level,and is running further than she everhas in the past. She has not reachedmenarche yet. She does not like todrink milk or eat dairy products(other than cheese on her pizza).She eats two meals per day (usuallyskips breakfast due to time con-straints) with a snack after practice.

Physical Examination:

Happy, healthy, thin young lady inno apparent distress. Walks with anormal gait. Examination of the legreveals no swelling, erythema orecchymosis. She is tender to palpa-tion on the posteromedial border ofthe tibia, at the junction of the prox-imal 2/3 with the distal 1/3. Nomuscle tenderness is elicited anteri-orly or laterally, and no firmness is

appreciated. Range of motion of theknee and ankle are full and pain-free. Strength at the knee and ankleare full and symmetric bilaterally.The right lower extremity is neuro-vascularly intact.

Radiographs:

AP and lateral of the right tibiaand fibula show a faint periostealreaction of the posteromedial borderof the tibial at the site of the pa-tient's pain. Otherwise normal films.DEXA scan reveals bones of ade-quate mineralization.

Diagnosis:

Tibial stress fracture, likely causedby a combination of overuse, inade-quate calcium and perhaps caloricintake.

Differential diagnoses:

Stress fractures must be distin-guished from other causes of lowerleg pain, including chronic exertion-al compartment syndrome, medialtibial stress syndrome, or even ten-donitis.

Discussion:

Tibial stress fractures (or anystress fracture) can be a presentingcomplaint for a syndrome known asthe Female Athlete Triad, a combi-nation of varying degrees of amen-orrhea, disordered eating, and de-creased bone mineral density.

This patient is 15 years old andhas not reached menarche yet, a di-agnosis now considered to be pri-mary amenorrhea, and abnormal forher age. If no hormonal, genetic, or

anatomic reason can be found forher amenorrhea, it is likely causedby inadequate caloric intake and thebody entering a starvation state.Treatment of this aspect of the syn-drome consists of adequate caloricintake to meet her growth require-ments and resting and activityneeds. Meeting with a registereddietitian can greatly help young ath-letes learn how to "fuel their sport"and meet caloric and nutritionguidelines by eating foods they al-ready enjoy. Patients will need tounderstand that skipping meals isgoing to decrease their athletic per-formance and can lead to injury.Further, adequate calcium intake canhelp prevent stress fractures.

Disordered eating can be consid-ered in any pattern of eating, con-scious or not, that does not meet thepatient's needs. In this patient, shelikely does not understand that miss-ing breakfast will decrease her per-formance and increase her chancesof injury. Further, she may not un-derstand that her increased load ofrunning will need to be "fueled" byan increase in the amount of foodshe eats each day, and that this maybe a significantly higher amount offood than she ate over her inactivesummer. Again, meeting with adietitian can help an athlete do themath to understand that increasingher food consumption will not makeher fat, but in fact, make her a betterathlete.

The patient's stress fracture is asymptom of either inadequate bone

See Case Study...on page 6

Ohio Pediatrics

6 www.ohioaap.orgOhio Pediatrics • Fall 2010

Case Study...from page 5

Annual Meeting...from page 1

mineralization (not likely in this pa-tient, due to her normal DEXAscan), or a relative decrease in thelaying down of bone mineralizationdue to her caloric restriction and in-adequate calcium intake. And this, inthe setting of simple overuse. Carry-ing a diagnosis of primary or sec-ondary amenorrhea, or oligomenor-rhea leads to an increase in the in-cidence of stress fractures.

Treatment of her stress fracturewill include absolute running activi-ty restriction, usually for about fourweeks, with permission to do non-weightbearing activities (weight lift-ing, swimming, aqua-jogging, bikingif tolerated without pain) providedthat she is able to provide caloricfuel for her recovery and activity. Inmost athletes, if dietary restrictionsare a concern, activity should not be

progressed until after her sessionwith the dietitian. Her diet shouldalso contain 1200-1500 mg of calci-um daily, with adequate Vitamin D,split into three servings per day, tomaximize absorption. Once the boneis healed clinically, the patient canbe progressed into a graded pain-free return to exercise, usually overthe course of 2-4 weeks.

The prognosis for these stressfractures is excellent. Most bonesheal in about 4-6 weeks with ade-quate comprehensive treatment, andfuture stress fractures can be avoid-ed with graded activity increases,adequate caloric and calcium intake,and good footwear.

– Anastasia Fischer, MDDepartment of Sports MedicineNationwide Children’s Hospital

Open Forummeetings setfor 2011

Each year Ohio AAP offerstwo meetings for pediatricians,behavioral health providers, leg-islators, residents, nurse practi-tioners and interested organiza-tions. These free meetings pro-vide time for an open dialogueabout health care in Ohio, andalso offer free continuing med-ical education credits.

The Open Forum meetings area great opportunity to learn andshare your thoughts with otherprofessionals from around thestate and at the same time influ-ence Ohio AAP policy.

If you haven't attended a pre-vious Open Forum meeting, theagenda begins with a brief 10-15 minute presentation by eachof the panelists followed byquestions and discussion. Thenaudience members break intosmaller groups and discuss waysthat the Ohio AAP can help withthe problem. A representativefrom each of these breakoutgroups then reports back to thegeneral group with their sugges-tions. These suggestions arethen taken to the Ohio AAPExecutive Board for considera-tion and action.

The 2011 meetings will beheld: January 28, 2011 – AthensTopics: Ounce of Prevention;Oral Health: Fluoride VarnishTraining

May 13, 2011 – University ofToledoTopic: Health-Care Reform

by 90%. Dr. Brown will addressmany aspects of parental refusal ofvaccines as part of the morning ses-sion at the Ohio AAP Annual Meet-ing Saturday, Nov. 6, at the MarriottNorthwest in Dublin. She will ex-plain how you can educate parentsand your staff to refute vaccinemyths and misconceptions.

Meg Fisher, MD, of MonmouthMedical Center, will speak on “Vac-cines, Not Just for Babies.” Dr.Fisher will discuss how to adviseteens and their parents about humanpapillomavirus vaccines and how tocounsel parents on the value of Tdapmeningococcal vaccine.

Pre-Annual Meeting workshops onFriday, Nov. 5 will deal with immu-nizations as well. Coding expertRichard Tuck, MD, Zanesville, willpresent immunization coding best

practices; tools to use in your prac-tice regarding parental refusal willbe presented by MOBI MedicalDirector Ryan Vogelgesang, MD,and Chris Rizzo, MD, HealthyPeople 2010 Advisory Committeemember; and case-based commonpediatric problems such as MRSA,flu, febrile infant and dysentery willbe presented by Robert Frenck,

MD, Cincinnati Children’s Hospi-tal, and Dr. Fisher.

An Opening Reception Fridayevening kicks off the Annual Meet-ing activities. At the members-onlybreakfast on Saturday, attendees willbe updated on Ohio AAP projectsand activities. The awards luncheonwill follow the Saturday workshops.

For more details, and to registeronline, go to the Ohio AAP websiteat www.ohioaap.org.

Ohio Pediatrics

7www.ohioaap.org Ohio Pediatrics • Fall 2010

Libby Ruppert inducted into Hall of FameStanding alongside a former mem-

ber of the Ohio House of Representa-tives, a philanthropist, a commandantin the Marine Corps, and a collegedean, former Ohio AAP PresidentElizabeth “Libby” Ruppert, MD,of Toledo was inducted into the OhioWomen’s Hall of Fame. The eventwas held Aug. 26 at the Ohio State-house.

Dr. Ruppert currently serves as themedical director of the Anne GradyCorporation Prescribed PediatricCenter and has spent her professionalcareer advocating for, and promoting,quality of life issues for medicallyfragile children. Dr. Ruppert alsoserves as a professor emeritus at theUniversity of Toledo Medical Col-lege. She also served as director ofthe Women’s Initiative of the UnitedGreater Toledo Area in 2006.

During her Ohio AAP Presidencyfrom 1995 to 2000, Dr. Ruppertlaunched Reach Out and Read, anearly literacy program used by allpediatric residency programs in Ohioas well as hundreds of Ohio pediatri-cians and family doctors in privateoffices and clinics. The Ohio AAPalso formed a charitable foundationand received the Outstanding LargeChapter award during her presidency.

In announcing the inductees intothe Hall of Fame, Gov. Ted Strick-land said, “These exceptional wo-men, all leaders in their fields, havedemonstrated an extraordinary com-mitment to excellence, achievementand service, often against great odds,with courage, determination andcompassion.”

The Ohio Women’s Hall of Famewas established in 1978 to publiclyrecognize the many outstanding con-tributions Ohio women have made tothe state and nation.

Former Ohio AAP President Elizabeth “Libby” Ruppert, MD, was inducted into

the Ohio Women’s Hall of Fame in August. Dr. Ruppert has spent her profession-

al career advocating for, and promoting, quality of life issues for medically fragile

children. She is currently the director of the Anne Grady Corporation Prescribed

Pediatric Center in Toledo.

100’s of Physiciansseeking jobs in Ohio

Medical Opportunities in Ohio (MOO) www.ohmoo.org – serves hospital employers

and private practices with an online recruitment

program, designed to connect Physicians,

Physician Assistants, and Nurse Practitioners

with jobs in Ohio. Job seekers register for

FREE! Our database of Physicians spans

more than 85 specialties!

Employers, contact us today to learn

more about how the MOO program can

work for you!

800.479.1666www.ohmoo.org

Ohio Pediatrics • Fall 20108 www.ohioaap.org

Ohio Pediatrics

You should join because Iam a member of the PROSnetwork! PROS (Pediatric Re-search in Office Settings) is aresearch network sponsored bythe Academy with the missionstatement focused on enhan-cing pediatric practice and im-proving child health.

The PROS network wasformed almost 25 years ago.PROS practitioners – just likeyou and me – have completed24 national studies that haveresulted in more than 65 pub-lished articles and 116 pub-lished abstracts. PROS studieshave been citied in more than1,000 publications. PROS ismarching on with a new effortto study electronic healthrecords. The initial missionremains to enhance processesin this evolving tool to im-prove pediatric practice andchild health care. PROS andthe contributions of PROSmembers have created newknowledge, changed publicpolicy, and made me a betterpractitioner.

Well, that sounds nice, but Iam just too busy to add onemore thing to my day.

I know you are busy. Youwill not have to add somethingevery day. You will not be par-ticipating in a study all of thetime. Some studies can becompleted in a week or two.Some may take a few months.

Why should youjoin PROS?

Ounce of Prevention strategies presentedthroughout Ohio

Through a Statewide Wellness and

Obesity Prevention Program Grant

awarded to the Ohio Chapter AAP,

the Ounce of Prevention information

and toolkit is being made available

to health-care providers throughout

the state.

The Ounce of Prevention is Worth

a Pound toolkit was developed to

address the growing epidemic of

childhood obesity. The goal is to

provide primary care providers with

simple tools to educate parents in

obesity prevention strategies by

making good nutritional and physi-

cal activity decisions for their chil-

dren.

Three regional trainings have al-

ready been held in Toledo, Young-

stown and Cleveland, and two more

will be held in Cincinnati/Dayton

and Athens. The dates are:

Wednesday, Dec. 1, 2010

2-3 p.m.

Cincinnati Children’s Hospital –

Liberty Campus

7777 Yankee Road

Liberty Township, Ohio

Friday, Jan. 28, 2011

Ohio University

Baker Center

Athens, Ohio

Additionally, eight webinars have

been scheduled to target those inter-

ested health-care providers who may

not be able to attend an in-person

training. The remaining dates for

webinars are:

Tuesday, Oct. 19 – 12-1 p.m.

Wednesday, Nov. 3 – 5:30-6:30

p.m.

Tuesday, Dec. 7 – 12-1 p.m.

On Thursday, Nov. 4, the Ohio

AAP will host a Learning Session

for 10-15 practices interested in par-

ticipating in a quality improvement

collaborative for Part IV MOC cred-

it. For more information, contact

Heather Hall at (614) 846-6258 or

hhall@ohioaap.org.

For more information on the

Ounce of Prevention trainings, or to

register for one of the regional or

webinar trainings, log onto www.

theounceofprevention.org.

The Ounce of Prevention program

was developed in collaboration with

the Ohio Chapter, American Acad-

emy of Pediatrics; the Ohio Depart-

ment of Health, Healthy Ohio; the

American Dairy Association Mid-

east; the Ohio Dietetic Association,

and Nationwide Children’s Hospital. See PROS...on page 19

www.ohioaap.org Ohio Pediatrics • Fall 2010 11

Ohio Pediatrics

SERVING STUDENTS IN GRADES K-12 WITH LEARNING DIFFERENCES

LOWER SCHOOLBroadview Heights

UPPER SCHOOLSagamore Hills

(440) 526-0717www.lawrenceschool.org

TEACH | IGNITE | INSPIRE

Don’t

LAWRENCE SCHOOL

Ohio AAP receives AAP Special Achievement Awardfor teen project

The Ohio AAP Chapter was rec-ognized at the District V meetingin Wisconsin in July for itsHealthy, Strong and Ready forTeens project. This daylong com-munity symposium held in April2009 brought parents and pediatri-cians together to address the spe-cial needs of pre-teen girls. Theevent gave parents the opportunityto discuss with general pediatri-cians and specialists various areasof interest specific to the health ofyoung girls.

Accepting the District V award are: from left, District V Chair Marilyn Bull,

MD; indiana Vice President Carolyn Lytle, MD; Ohio AAP President Gerald

Tiberio, MD; indiana Co-President Dawn Haut, MD; Ohio AAP Executive

Director Melissa Wervey Arnold; Michigan President Lawrence Reynolds, MD;

Ohio AAP President-Elect Judy Romano, MD; Michigan District Officer

Charles Barone, MD; indiana Co-President Sarah Stelzner, MD; District V

Vice Chair Rick Tuck, MD; and Denise Sloan, Michigan Executive Director.

Ohio Pediatrics • Fall 201012 www.ohioaap.org

Ohio Pediatrics

Resident CATCH Grant

While breastfeeding provides un-

contested benefits to both mother and

infant, a CDC National Immunization

Survey reported 2007 breastfeeding

initiation rates of 59.7% in mothers

less than 20 years old. Rates are 10

to 20% higher in women above this

age group.

In an attempt to impact this dispari-

ty, residents and medical students

from the University of Toledo, under

mentorship of Joan Griffith, MD,

were awarded a Resident CATCH

grant for the initiative “Friends for

Teen Breastfeeding.” The initiative

targeted the Polly Fox Academy (a

Teen breastfeeding initiativepublic high school for pregnant and

parenting teen girls) with the goal of

increasing breastfeeding support and

rates within the school.

The Infant Iowa Feeding Attitude

Survey (IIFAS), a previously vali-

dated infant feeding survey, as well

as self-designed surveys, were uti-

lized to assess the girl’s attitudes

toward breastfeeding and investigate

factors influencing their infant feed-

ing choices. Personal interviews and

focus groups were also conducted.

Using the IIFAS, the group found

that 80% of those surveyed had neu-

tral attitudes and 20% had positive

attitudes toward breastfeeding.

Those involved agreed there is a sig-

nificant opportunity for pediatricians

and other health-care workers to en-

courage and talk about breastfeeding

with their adolescent patients. Col-

laborators utilized survey and focus

group data in developing breastfeed-

ing education materials.

Over the 2009-2010 school year,

six breastfeeding education sessions

were held with collaboration be-

tween Lucas County WIC, school

representatives, pediatric residents

and medical students. The sessions

increase rates on certain primary

care codes. One of the biggest victo-

ries in this area was increasing the

vaccine administration reimburse-

ment by 100%! While we will con-

tinue to fight for fair payment, we

know in the next few years this is-

sue will be incredibly critical as the

state is facing an $8 billion deficit.

Over the next year, we will be call-

ing on you to help us in educating

legislators and payers on the impor-

tance of fair payment for Medicaid

services. We hope you will stand

with the Chapter on this important

issue.

In addition to reimbursement, we

will be working closely with state

government officials as health-care

reform regulations begin to surface,

and will provide information and re-

sources as we navigate through

these changes, as well as continue to

advocate for the best interest of

Ohio’s children and pediatricians in

these reforms.

Along the lines of advocacy, one

of the notable responses from this

portion of the survey was the high

request for more advocacy training.

Again, this will be a high priority,

especially in terms of the state’s

budget, and we hope you will join

us at our training opportunities.

This past year, under the leadership

of our Young Physicians and Resi-

dents Committee, led by Allison

Brindle, MD, Emily Decker, MD,

and Norah Ledyard, DO, along

with the assistance and planning of

a resident, Natalie Riedmann, MD,

the Chapter offered a SOLD OUT

advocacy training free of charge to

all members with a focus on resi-

dents and young physicians. The

tremendous turnout not only shows

the dedication to this issue by the

planning physicians, but also the

strong desire for this information

from our membership. If advocacy

efforts are of interest to you, please

watch for announcements of training

opportunities in Ohio Pediatrics or

our online publications, or feel free

to contact Melissa Wervey Arnold at

the Chapter offices, or Bill Cotton,

MD, the Chapter’s Pediatric Advo-

cacy Chair.

Again, thank you to all who took

the time to respond to the survey.

Some of the issues raised are cur-

rently being addressed and the infor-

mation gathered will be prioritized

with time and resources. As always,

if you have additional comments or

feedback, please take a moment and

contact any of the Chapter leader-

ship or staff. Your energy and exper-

tise are always welcome.

– Gerald Tiberio, MD, President

Melissa Wervey Arnold,

Executive Director

Survey...from page 3

See CATCH...on page 19

www.ohioaap.org Ohio Pediatrics • Fall 2010 13

Ohio Pediatrics

Clark Kellogg and “Goodnight Moon”make Breakfast for Books a success

Fourth Annual Reach Out and Read Ohio fundraiser brings in nearly $12,000 for statewide program

Reach Out and Read Ohio would liketo extend a Thank You to Breakfastfor Books 2010 Sponsors and Sup-porters.

Where the Wild Things Are

Sponsor:

Drs. John C. Duby and Sara F.Guerrero-Duby

if you Give a Mouse a Cookie

Sponsors:

Akron Children’s Hospital Nationwide Children’s Hospital University of Toledo Medical Center,Department of Pediatrics

Very Hungry Caterpiller

Sponsors:

Center for Cognitive and BehavioralTherapy of Greater ColumbusMcDonalds, USA, LLC

Table Sponsors:

Edwin & Carol HallThad & Barbara Matta

Raffle items were donated by:

Richard & Sally JamesonJohn R. Green CompanyLori LeGendreThad MattaThe Step 2 Company, LLC

Special Thank you to:

Jeff Hogan Clark KelloggOhio AAP FoundationOhio UnionReach Out and Read Ohio AdvisoryCommittee

Jeff Hogan, WBNS 10-TV news anchor,was the emcee for this year’s event,which saw the largest crowd in theevent’s history at nearly 130. The eventwas held in the new Ohio Union on theOSU campus.

Through raffle ticket and centerpiecesales, attendees and sponsorships,Breakfast for Books raised nearly$12,000 for Reach Out and ReadOhio on Sept. 10.

Drs. Martha Kleinberg, and thelate Warren Kleinberg, werehonored for their dedication andcommitment to the ROR pro-gram. Lori LeGendre, ProgramDirector for ROR NorthwestOhio, accepted the award.

A Champion of the year award was givento American Elite Allstars, inc., for dona-tions of $72,000 and more than 41,000 newand gently used books to the Akron area,over the past five years.

Students and teachers from the G. TyreeLearning Center in Columbus were guest atten-dees, thanks to the generosity of sponsors Drs.John Duby and Sara Guerrero-Duby, andAkron Children’s Hospital.

Ohio AAP President Gerald Tiberio,MD, opens the fourth annual Break-fast for Books event by telling howReach Out and Read has been benefi-cial in his own pediatric practice.

14

Ohio Pediatrics

Ohio Pediatrics • Fall 2010

Legislation...from page 2

Ohio Attorney General

Former Republican United StatesSenator and former Lieutenant Gov-ernor Mike DeWine will challengecurrent Democrat Attorney GeneralRichard Cordray to serve as Ohio’slead attorney.

Ohio Auditor

With incumbent Mary Taylor joininggubernatorial candidate John Kasichon the ticket as the candidate forlieutenant governor, a couple of rela-tive “unknowns” will be on the ballotfor state auditor. Republican Dela-ware County Prosecutor Dave Yostand Democrat David Pepper will viefor the seat in the fall election.

Ohio Secretary of State

Sen. Jon Husted (R-Kettering) facesDemocrat Maryellen O'Shaughnessyfor Ohio’s secretary of state.

Ohio Treasurer

Incumbent Democrat Kevin Boycewill face a strong challenge by StateRep. Josh Mandel (R-Lyndhurst).Many around Capitol Square predictthat this race is “in the bag” for Rep.Mandel, an attorney, Iraq war veteranand prolific fundraiser.

Ohio Senate

Sixteen of the 33 Senate seats are upfor election this year (7 Republicanand 9 Democrat). As Republicanshold a 21-12 majority in this cham-ber, a change in leadership is not ex-pected. Dramatic upsets are alsounlikely.

Ohio House

With all eyes on the majority, bothparties in the Ohio House will be tar-geting swing districts. For those whohave followed Ohio politics in the

past, many of the key races for 2010have been the key races in years past.Races to watch include:

HD 17 – With current Rep. JoshMandel running for Ohio Treasurer,Republican Marlene Aneilski, mayorof Walton Hills, will be facing offagainst Democrat Kelli Perk, an as-sistant prosecuting attorney fromBroadview Heights.

HD 19 – Republican Ann Gonzales,mayor of Westerville, a Columbussuburb, is waging an active campaignagainst Rep. Marian Harris (D-Columbus).

HD 20 – Incumbent Democrat Rep.Nancy Garland faces a challenge byRepublican Matt Carle, an attorneyand campaign staff veteran.

HD 50 – Rep. Todd Snitchler (R-Uniontown) worked hard to win thisseat two years ago. He will have towork just as hard with a challengefrom Democrat Todd Bosley, a StarkCounty Commissioner.

HD 42 – Republican challengerKristina Roeger, an engineer with anMBA serving on Hudson City Coun-cil, will face off against Rep. MikeMoran (D-Hudson).

HD 46 – This is the race to watch inNorthwest Ohio as Rep. BarbaraSears (R-Maumee) faces a challengefrom Harry Barlos, an administratorfor the Village of Holland and formerLucas County Commissioner.

HD 63 –Rep. Mark Scheider (D-Mentor) will face former state repre-sentative Ron Young from LeroyTownship in the November election.

HD 85 – In a district that almost al-ways has a heated race, Rep. RayPryor (D-Chillicothe) faces Repub-lican Bob Peterson, a family farmerfrom Fayette County.

HD 89 – As Rep. Todd Book leavesthis seat due to term limits, DemocratRon Hadsell, a Portsmouth construc-tion executive, will be runningagainst Dr. Terry Johnson, a Repub-lican physician and colonel in theOhio National Guard.

HD 91 – Republican Bill Hayes, anattorney from Caldwell, will chal-lenge Rep. Dan Dodd (D-Hebron).

– Capitol Consulting GroupOhio AAP Lobbying Team

ImmunizationAdvocacy Networkof Ohio to meet

Join us before the 2010 OhioAAP Annual Meeting on Friday,Nov. 5 from 8 to 9 a.m. at theMarriott Northwest in Dublinprior to the Annual Meeting foran Immunization Advocacy Net-work of Ohio meeting.

This new network will bringtogether a broad range of organi-zations and individuals who be-lieve in the critical importance ofimmunization.

If you are interested, or wouldlike more information, contactMelissa Wervey Arnold, OhioAAP Executive Director, at (614)846-6258 or e-mail chapter@ohioaap.org.

15www.ohioaap.org Ohio Pediatrics • Fall 2010

Ohio Pediatrics

Reach Out and Read Ohio educatesproviders on early literacy skills

Teaching children to read can be aseasy as reading to children on a dailybasis. Reading aloud to children isthe single most effective thing par-ents can do to help prepare their chil-dren to succeed in school. That iswhy Reach Out and Read makes lit-eracy promotion a standard part ofevery well child visit from 6 monthsthrough 5 years old.

This message was reinforced at the2010 Reach Out and Read OhioAnnual Meeting on Sept. 29 at theState Library of Ohio in Columbus.

The meeting started with a keynotepresentation by Kathleen Hayes, edi-tor of Highlights High Five maga-zine. Her presentation, “For the Loveof Literacy: How reading aloud canhelp young children develop six keyearly literacy skills” outlined howvocabulary, print motivation, letterknowledge, print awareness, phono-logical awareness and narrative skillshelp prepare children to read.

In addition to explaining each ofthese six skills in detail, Hayes pro-ceeded to show attendees how theseskills are the foundation of the High-lights High Five magazine. At theend of the meeting, attendees re-ceived several hundred back issues ofthe magazine to take back to theirpractices and share with families.

After the keynote presentation, thesix skills were again discussed at twointeractive sessions lead by children’sauthor, Michael J. Rosen, and thePublic Library of Cincinnati and

Statewide Annual Meeting for providers, coordinators and volunteers reinforces messages in fun and informative manner

Kathleen Hayes, editor of Highlights High Five magazine, was the keynote speak-er at the Reach Out and Read Ohio Annual Meeting where she discussed the sixkey early literacy skills children need to learn.

Using dialogic reading and storytime,children’s librarian Natalie Fields, dis-cussed the role of public libraries inbuilding literacy rich environments forchildren.

Robert Needlman, MD, allows chil-dren’s author, Michael J. Rosen, tountie his shoes during an exerciseshowing how parents can use shoelacesto create letters of the alphabet. See ROR...on page 17

16 Ohio Pediatrics • Fall 2010 www.ohioaap.org

Ohio Pediatrics

Funding from CareSource will securecontinuation of Asthma Pilot Project

With the Chapter Quality Network(CQN) Asthma Pilot Project wind-ing down, the Ohio AAP was re-cently awarded a $75,000 SignatureGrant from the CareSource Foun-dation to support a second wave ofquality improvement work forOhio’s pediatric asthma patients.

The CareSource Foundation ispart of CareSource, a non-profit,public-sector managed-care com-pany, which has become one of thelargest and fastest growing Medi-caid managed-care plans in the na-tion.

“CareSource is committed to giv-

ing back and supporting health ini-tiatives that impact our members,”said Pamela Morris, President andCEO, CareSource. “As a health planthat serves the underserved, we un-derstand the emotional and financialburden that is placed on familiescaring for children with asthma, andwe’re glad to be able to support thispilot that improves the quality ofcare.”

In the first wave of the CQNAsthma Pilot Project, 13 practiceswith nearly 80 physicians worked toimprove patient care. An additional

P. Cooper White, MD, right, physician

leader for the CqN Asthma Pilot Pro-

ject, receives a check from Gail Croall,

MD, senior medical director for Care-

Source, to support a second wave of

the Asthma Pilot Project.See Asthma...on page 19

We’ve Got Your Back!Exceptional Coverage. Proven Stability.

You can practice with con�dence, knowing that American Physicians o�ers the exceptional protection and �nancial stability you deserve. Year after year, we set the standard with:

Competitive ratesRange of coverage options – including our unique

TailGard® policy (claims-made with pre-paid tail coverage)33% higher annual aggregate limitsFree on-site risk management assessmentsIndustry-leading claims serviceA- (Excellent) rating from A.M. Best

For a free premium quotation, visit www.apassurance.com, call 800-748-0465 (select option 3), or e-mail marketing@apassurance.com.

Endorsed by Medical Societies Headquartered in the Midwest

www.ohioaap.org 17Ohio Pediatrics • Fall 2010

Ohio Pediatrics

Among themany challengesand opportunitiesfacing pediatri-cians in the fall of2010, none isgreater than that offacilitating imple-mentation of thebenefits ofhealth-care re-form for children inherent in health-care reform (ACA) passed by Con-gress last March. Health care for allchildren is within reach but the job isnot done. Access to excellent care isa major issue for children and if wecan take advantage of the potentialbenefits in ACA, access will be im-proved and pediatricians will be paidmore appropriately for their services.Your Chapter leadership is activelyinvolved with state government,

District V Report

Marilyn Bull, MD

Take advantage of benefits in ACAchildren’s coalitions, and membersof the legislature to advance thecause of children and pediatriciansin this effort. The national AmericanAcademy of Pediatrics is contribu-ting expertise as well and frequentcommunication occurs between yournational and state leaders.The De-partment of State and GovernmentAffairs has developed new resourceswhich are continually updated andcan be accessed on the AAP.org website on the “Members Only Center”under the heading of that departmentand titled State Health - State Imple-mentation of the Patient Protectionand Affordable Care Act (ACA)(http://www.aap.org/securemoc/stgovaffairs/acastatehealth.doc)

What can you do? Communicateyour concerns and specific problemsto the Chapter. Attend your statemeeting Nov. 5 and 6 and learn the

details of current initiatives. An ex-cellent program is planned for themeeting and it is a wonderful oppor-tunity to communicate your specificissues. You can also attend an OpenForum to discuss your ideas withhealth care and other professionals.Your voice will be heard!

Your district is continuing to focuson collaborative efforts to enhancethe role of subspecialists and youngphysicians. Your input and partici-pation in these endeavors will pro-vide depth to the potential benefitsand ensure that your needs are met. Iurge you to again share with yourpresident Dr. Gerald Tiberio andmyself any suggestions or ideas youhave in this regard.

Best wishes for a wonderful fall.

– Marilyn Bull MD, FAAPDistrict Chairperson

Hamilton County children’s librarianNatalie Fields.

Fields’ session reviewed how Ohiopublic libraries support early litera-cy, especially through the Ready toRead program. She also discusseddialogic reading, and how askingchildren to explain pictures in bookscan help them comprehend wordsand phrases as they grow older.

Letter knowledge was the primaryfocus of Rosen’s session, which fol-lowed his book You, Me and theABCs: 100 Ready-for-Reading Acti-vities for You and Your FavoriteGrown-up. Using everyday house-hold items, and some imagination,Rosen taught many ways for chil-dren to recognize, say, and write the

letters of the alphabet. During lunch, Katie Sabol, refer-

ence librarian at the State Library ofOhio, introduced attendees to theresources and services available atthe library.

In addition to the educational ses-sions, attendees were able to minglewith several book companies includ-ing AKJ Books; Books By TheBushel, LLC; Guardian Book Com-pany; John R. Green & ContinentalPress; Star Bright Books; ThirdWeek Books; and Usborne Booksand More.

For more information on ReachOut and Read Ohio, visit www.ohioaap.org/program-initiatives/reach-out-and-read.

ROR...from page 15

Looking for the

perfect fit?

The next time you need

to fill a position with a

qualified medical

professional...use the

Ohio AAP Career

Center

www.ohioaap.org

18 Ohio Pediatrics • Fall 2010 www.ohioaap.org

Ohio Pediatrics

Golfers support Foundation to a “tee” The fourth annual Ohio AAP Foun-

daton Golf Outing on Aug. 31 washeld at Rattlesnake Ridge Golf Clubin Sunbury, Ohio. The golf outingraised close to $7,000 to support theOhio AAP Foundation and the Foun-dation’s My Story Foster Care Pro-gram.

The Ohio AAP Foundation appre-ciates the support of the followinggroups and individuals in making the2010 Golf Outing a success

Birdie Sponsor:

Nationwide Children’s Hospital

Foursome Sponsor:

Buckeye Community Health PlanChildren’s Practicing PediatriciansCommerce National BankIndustrial Technology SolutionsOhio Children’s Hospital Association

Raffle Prize & Contest Donors:

John Duby, MDJohn HowenstineJohnny Buccelli’sPaneraP.F. Chang’sRed Lobster Rusty BucketThad & Barbara Matta

Ohio AAP Executive Director MelissaWervey Arnold showed off her newgolf game.

Finishing one stroke off the lead was Nationwide Children’s Hospitalgolfers, Bruce Meyer, MD, (putting), John Barnard, MD, (left),Grant Morrow, MD, (right), and Greg Bates, MD, (not shown).

John Duby, MD, President of the OhioAAP Foundation, watches his putt as itnears the yellow flag. Dr. Duby part-nered with Jessica Gliha and JustinBaker of Commerce National Bank.

Watching as Jo Ann Rohyans, MD, sinks a putt,Traci intihar of Capitol Consulting was the win-ner of two raffle prizes.

The Buckeye CommunityHealth Plan foursome ofTodd McCullough, SteveWhite, John Wiley andTom york, finished theday with a 60, to win theOhio AAP FoundationGolf Outing for the second year in a row.

Ohio Pediatrics

19www.ohioaap.org Ohio Pediatrics • Fall 2010

When a study is set up by the net-work, you will get a notice about it.You will have an opportunity toreview the study design and decide ifyou are interested. Next, you canlook further to see if it fits your prac-tice. If you have more questions, youcan contact PROS and get more in-formation. As one of the Chapter Co-ordinators, I can assure you eachstudy is vetted so you can participatewith minimal impact on your patientsor practice.

What will my patients think if I amdoing research?

My experience had been totallypositive. In fact, I would say it is anasset. I commonly supplement a dis-cussion with a parent or colleague byadding that I am a member of a na-tional pediatric research networkcalled PROS that has done a study onthis topic. If I personally participatedin the study, I add that information aswell. To use a political term, it adds“gravitas” to my comments.

Hopefully my enthusiasm forPROS has added to your interest. Iwould be happy to discuss this fur-ther with you on a personal basis.Let me also suggest that you learnmore about PROS by reading a re-cently published article in the JunePediatric Annals titled “PROS: AResearch Network to Enhance Prac-tice and Improve Child Health.” Ifthe journal isn’t handy, you can go towww.PediatricSuperSite.com and justtype PROS in the Google search win-dow.

– James B. Davis, MD, FAA Pdrjbdav@aol.com

PROS...from page 8 CATCH...from page 12

Asthma...from page 16

ranged from breastfeeding “Family

Feud” to “Pumping Basics.” One

session was peer-led, consisting of a

panel of Polly Fox students who

shared their breastfeeding experi-

ences with their classmates. The ses-

sions attempted to emphasize open

communication, extinguish breast-

feeding fears and increase the

breastfeeding “cool” factor. The

lunch time sessions were well re-

ceived and 72 attended.

While collaborators found mea-

surement of impact challenging,

nearly all who attended the final ses-

sion admitted they were more will-

ing to try breastfeeding after attend-

ing the session(s). Additionally,

three adolescents delivered their in-

fants in the last month of school and

each initiated breastfeeding. All

three had attended one of our breast-

feeding sessions.

We would like to sincerely thank

all those involved who supported

our project, especially the AAP

CATCH program for their financial

support. Although the Resident

CATCH grant “Friends for Teen

Breastfeeding” has concluded, the

Polly Fox Academy and WIC con-

tinue to provide regular breastfeed-

ing support to the attendees of the

Polly Fox Academy.

The CATCH Resident Funds Pro-

gram is a great way to support advo-

cacy among pediatric residents. Ap-

plications for the next cycle will be

available Nov. 1, 2010 thru Jan. 31,

2011. Applicants will be notified of

funding decisions by June 30, 2011.

– Norah Ledyard, DO

Danielle Paulozzi, MS4

15-20 practices will be recruited toparticipate in the second wave of theproject, which is expected to start inearly 2011.

Participating practices have stead-ily improved patient care over thepast 11 months of data collection.During baseline data collection inOctober 2009, a meager 37% of pa-tients were receiving “optimalasthma care” at their visits. Optimalcare is defined as that which in-cludes: use of a validated instrumentto assess a patient’s asthma control;a stepwise approach is used to iden-tify treatment options, or adjust cur-rent therapy; a flu shot, or flu shotrecommendation, for all patients 6months of age or older; and a writ-ten asthma action plan.

For the past five months, the opti-

mal care measure has held steady atabout 80%. Two additional measuresCareSource has studied are the per-centage of patients with one or moreasthma-related Emergency Depart-ment or Urgent Care visits withinthe past 12 months, and the percen-tage of patients with one or moreasthma-related hospitalizations with-in the past 12 months. Both meas-ures have seen steady decreases,especially in the past six months.CareSource reports a decrease ofapproximately 30% in both meas-ures from their membership at theparticipating practices.

For more information on thesecond wave of the CQN AsthmaPilot Project, contact Heather Hall at(614) 846-6258 or hhall@ohioaap.org.

The Ohio AAP announces the following meetings and events.

Nov. 4 – quality improvement Learning Session for Obesity Prevention CollaborativeMarriott Northwest, Dublin, OH

Nov. 5-6 – 2010 Ohio AAP Annual MeetingMarriott Northwest, Dublin, OH

Dec. 1 – Ounce Regional TrainingCincinnati Children’s Hospital, Liberty Township

Jan. 28, 2011 – Open Forum Meeting Baker Center, Ohio University, Athens, OH

– Ounce Regional TrainingBaker Center, Ohio University, Athens, OH

– Executive Committee MeetingBaker Center, Ohio University, Athens, OH

May 13, 2011 – Open Forum MeetingUniversity of Toledo

Calendar of Events

Dues remitted to the OhioChapter are not deductible asa charitable contribution, butmay be deducted as an ordi-nary and necessary businessexpense. However, $40 ofthe dues is not deductible asa business expense becauseof the chapter’s lobbyingactivity. Please consult yourtax adviser for specific infor-mation.

This statement is in refer-ence to fellows, associatefellows and subspecialty fel-lows.

No portion of the candidatefellows nor post residencyfellows dues is used for lob-bying activity.

Ohio ChapterAmerican Academy of Pediatrics450 W. Wilson Bridge Rd. Suite 215Worthington, OH 43085

PRESORTEDSTANDARD

Permit No. 156

U.S. PostagePAID

DUBLIN, OH

Dues disclosure

statement